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Background: Postoperative physical therapy emerges as a pivotal element of the rehabilitation process, aimed at enhancing functional recovery, managing pain, and mitigating the risk of further complications. The debate concerning the optimal timing of physical therapy intervention post-surgery remains unresolved; in particular, whether to initiate physical therapy immediately or to wait weeks is of particular interest. The aim of this study is to review the available literature regarding the optimal timing of physical therapy initiation and the outcomes obtained. Methods: This review was carried out in accordance with the Preferential Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. This search was carried out in February 2024. Only peer-reviewed articles were considered for inclusion. Results: Fourteen studies were included. The primary outcomes assessed in the included studies were the following: 12-week and 12-month low back pain, return to work, function and disability, psychological status, patient satisfaction, and complications associated with early physical therapy. A meta-analysis was performed concerning low back pain after lumbar discectomy at 12 weeks and 12 months and complications after early physical therapy after lumbar discectomy and lumbar interbody fusion. A significant difference was found between early and standard physical therapy in terms of low back pain at 12–18 months (p = 0.0062); no significant differences were found in terms of complications, both for discectomy and arthrodesis. Conclusions: This review indicates that employing early rehabilitation strategies for intervertebral disc disease could enhance results in terms of pain and disability without an enhanced risk of complications. [ABSTRACT FROM AUTHOR]

This study compared the functional efficacy of therapeutic transforaminal versus interlaminar epidural steroid injection. Adult patients were selected and randomized using an online research randomizer website and assigned into two groups and were given epidural injection either via transforaminal route or interlaminar route. The outcome was measured based on the Modified Japanese Orthopedic Association back index score (mJOA), Oswestry disability index (ODI), and visual analog scale (VAS) over a follow-up on 1st, 3rd, and 6th month postinjection period. It was found that there was no significant difference seen in m JOA, ODI, and VAS score at 1 month, 3 months, and 6 months between transforaminal and interlaminar epidural steroid injection. Pain management in the epidural route was comparable to the interlaminar route. Even though the transforaminal epidural route has the advantage of being a selective nerve route block, it has similar results as the interlaminar route at 6 months follow-up.

This study compared the functional efficacy of therapeutic transforaminal versus interlaminar epidural steroid injection. Adult patients were selected and randomized using an online research randomizer website and assigned into two groups and were given epidural injection either via transforaminal route or interlaminar route. The outcome was measured based on the Modified Japanese Orthopedic Association back index score (mJOA), Oswestry disability index (ODI), and visual analog scale (VAS) over a follow-up on 1st, 3rd, and 6th month postinjection period. It was found that there was no significant difference seen in m JOA, ODI, and VAS score at 1 month, 3 months, and 6 months between transforaminal and interlaminar epidural steroid injection. Pain management in the epidural route was comparable to the interlaminar route. Even though the transforaminal epidural route has the advantage of being a selective nerve route block, it has similar results as the interlaminar route at 6 months follow-up. [ABSTRACT FROM AUTHOR]

Background: Postoperative physical therapy emerges as a pivotal element of the rehabilitation process, aimed at enhancing functional recovery, managing pain, and mitigating the risk of further complications. The debate concerning the optimal timing of physical therapy intervention post-surgery remains unresolved; in particular, whether to initiate physical therapy immediately or to wait weeks is of particular interest. The aim of this study is to review the available literature regarding the optimal timing of physical therapy initiation and the outcomes obtained. Methods: This review was carried out in accordance with the Preferential Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. This search was carried out in February 2024. Only peer-reviewed articles were considered for inclusion. Results: Fourteen studies were included. The primary outcomes assessed in the included studies were the following: 12-week and 12-month low back pain, return to work, function and disability, psychological status, patient satisfaction, and complications associated with early physical therapy. A meta-analysis was performed concerning low back pain after lumbar discectomy at 12 weeks and 12 months and complications after early physical therapy after lumbar discectomy and lumbar interbody fusion. A significant difference was found between early and standard physical therapy in terms of low back pain at 12–18 months (p = 0.0062); no significant differences were found in terms of complications, both for discectomy and arthrodesis. Conclusions: This review indicates that employing early rehabilitation strategies for intervertebral disc disease could enhance results in terms of pain and disability without an enhanced risk of complications.

Objective To study the indications, technical nuances, learning curve, and outcomes associated with minimally invasive tubular discectomy of spine (MITDS) and minimally invasive tubular decompression (MITD) using the tubular retractor system and compare the outcomes with open microdiscectomy and open decompression. Materials and Methods All patients who underwent MITDS and MITD received a trial of conservative management for 6 weeks prior to surgery. Patients who had undergone open microdiscectomy and open decompression during the same period were used as controls. Operating time, intraoperative blood loss, preop and postop visual analogue scale (VAS) scores, preop and postop Oswestry disability index (ODI) scores, duration of hospital stay, complications, and need for redo surgery were analyzed. Results Thirty-two patients who underwent MITDS and 8 patients who underwent MITD were compared with an equal number of patients who underwent open microdiscectomy and open decompression, respectively. MITDS and MITD were associated with shorter hospital stay. Short-term pain outcome was better in MITDS and MITD group, although it was not statistically significant in MITD group. Functional outcome measured in terms of ODI at 6 months was not statistically significant between minimally invasive and open procedures. Conclusion Both MITDS and MITD have a significant learning curve and have a distinct advantage of shorter hospital stay. MITDS has the distinct advantage of better short-term pain relief compared with open procedures. For MITD, comparison of short-term pain relief requires a larger sample size. To establish long-term advantages of MITDS and MITD, larger sample size and long-term follow-up are needed.

Background: The vertebral column represents the axial skeleton and has an indispensable role in the protection of the spinal cord. Early identification of its pathologies and an adequate treatment are essential for a favorable outcome. Methods: For the selection of the articles included in this review work, the PubMed database was searched, using the following queries: "acute lumbar back pain, chronic lumbar disc pain, intervertebral disc disease, lumbar intervertebral disc injury, lumbar spine intervertebral disc x -ray imaging, lumbar spine intervertebral disc magnetic resonance imaging, intervertebral lumbar disc treatment options". A total of 2756 articles resulted from the search with the previously mentioned keywords, and after identifying and removing duplicates, 2063 references remained. After applying the free full-text criterion, 532 articles resulted, and the subsequent application of the novelty criterion (articles from the last 5 years, 2018-2023) led to the selection of 241 references. The inclusion and exclusion criteria defined in the present paper were applied to these 241 references, resulting in 178 articles, of which 36 articles were finally included in the paper, following an impact-factor-based quality assessment. Literature review: These 36 articles were reviewed based on the criteria: etiology and etiopathogenesis of lower back pain, classification and description of lumbar disc diseases, as well as their diagnosis and treatment. Conclusions: Lumbar disc diseases are a real burden in the lives of patients from a psychological, social and professional point of view. They limit the ability to perform the previously-carried-out activities, thus reducing the quality of life of patients. An early diagnosis, followed by the initiation of treatment, are essential in the management of these pathologies that are increasingly common nowadays. [ABSTRACT FROM AUTHOR]

Background: Surgery is a well-known and effective method of treating lumbar intervertebral disc herniation. The present study aimed to compare the effects of administering tranexamic acid (TXA), nitroglycerin (NTG), and remifentanil (REF) on hemorrhage prevention during herniated lumbar intervertebral disc surgery. Methods: A double-blind clinical trial was conducted on 135 participants undergoing lumbar intervertebral disc surgery. A randomized block design was used for subject assignment to three groups including TXA, NTG, and REF. The hemodynamic parameters, bleeding rate, hemoglobin level, and the amount of infused propofol were measured and recorded after surgery. Data were then analyzed in SPSS software using Chi-square test and analysis of variance. Results: The mean age of participants in the study was 42.12 ± 7.93 years, and all three groups were equal in terms of demographic characteristics (P > 0.05). The mean arterial pressure (MAP) of the TXA and NTG groups was notably higher than the REF group (P < 0.008). The mean heart rate (HR) of the TXA and NTG groups was notably higher than the REF group (P < 0.05). The propofol dosage used in the TXA group was higher than the two groups of NTG and REF (P < 0.001). Conclusion: Among participants undergoing lumbar intervertebral disc surgery, the greatest MAP variability was observed in the NTG group. Higher mean HR and propofol consumption was observed in the NTG and TXA groups when compared to REF. No statistically significant differences were noted between groups in oxygen saturation or bleeding risk. Based on these findings, REF may be considered a preferred surgical adjunct over TXA and NTG during lumbar intervertebral disc surgery. [ABSTRACT FROM AUTHOR]

The incidence of lumbar disc fragment migration is approximately 35%–72% of which 34% are high-grade up-migrated discs. Translaminar keyhole approach is a minimally invasive and true tissue sparing technique which has been applied to approach migrated disc herniation. The unilateral biportal endoscopic approach is an emerging technique among endoscopic spine surgery that combines the advantages of microscopic surgery with endoscopic surgery. In this technical report we demonstrate the surgical technique of performing the translaminar keyhole approach with unilateral biportal endoscopic spine surgery to treat high-grade up-migrated discs. As far as we know, this is the first technical report of unilateral biportal endoscopy with translaminar keyhole approach to treat high-grade up migrated lumbar disc herniation.

Background: Intradural herniation (IDH) or transdural disc herniation is a rare presentation of lumbar disc disease. Preoperative imaging findings should be carefully and thoroughly interpreted. Although imaging modalities such as computed tomography (CT) or magnetic resonance imaging (MRI) are readily available, a definitive diagnosis cannot be made based solely on these modalities. Operative procedures must be planned to prevent unexpected complications. Case description: A 67-year-old man presented with right lower extremity weakness and numbness with bowel and bladder involvement for 2 weeks, after falling from a standing position. MRI revealed a large herniated disc at L2-L3, which was suspected to be IDH. Posterior discectomy and interbody fusion were also performed. Intraoperative findings revealed no disc material in the epidural space or dural sac tenting. Dorsal midline durotomy was performed, and a mass-like lesion was found and resected. Subsequently, pathological analysis revealed disc tissue with evidence of moderate chronic inflammation and a focal increase in fibrosis. The patient was discharged without complications. Results (Outcome): Lower extremity strength improved to grades IV-V, accompanied by a return to normal bowel and bladder function within 1 month, without any wound complications. Lower extremity strength recovered fully to grade V, and the patient started walking independently within 6 months. Conclusions: A large disc herniation, suspected to be an IDH, should be thoroughly investigated by carefully reviewing MRI scans before proceeding with any surgical procedure to prevent unexpected situations. Nonetheless, preoperative imaging alone does not ensure a definitive diagnosis, and the differential diagnosis must include other mass-like lesions. Intraoperative findings and pathological reports are essential for definitive diagnosis of IDH.

Introduction: There is a growing number of publications highlighting sarcopenia and myosteatosis as poor prognosic factors for treatment results in oncological patients. The decrease in the cross-sectional area (CSA) of the multifidus muscle and muscle steatosis is associated with lumbar disc herniation and low back/limb pain. Nevertheless, no studies have analyzed the influence of the above parameters on patient satisfaction, pain decrease and return to daily activities. The aim of the study was to verify whether decreased preoperative CSA of the paraspinal and psoas major muscles and their fatty degeneration (myosteatosis) may influence the outcome of surgical treatment of lumbar disc disease (LDD). Materials and methods: One hundred and one patients with LDD undergoing open microdiscectomy were enrolled in the analysis. Relative cross-sectional areas (rCSA) of the paraspinal and psoas major muscles as well as their fatty degeneration were measured. Patients were assessed according to the validated Polish versions of the EURO EQ-5D, Core Outcome Measure Index (COMI), Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) 1 and 6 months postoperatively. The association between the variables was calculated using Pearson r and Spearman rank correlation. The Kruskal–Wallis test was used to compare the results between the groups with different rCSA of paraspinal and psoas major muscles and a different degree of paraspinal muscle myosteatosis. Results: Fatty degeneration of the paraspinal muscles correlated with better outcomes 1 and 6 months postoperatively according to ODI (P = 0.003 and P = 0.027, respectively). Patients with higher rCSA of the paraspinal and psoas major muscles achieved better results on the EURO EQ-5D scale (P = 0.0289 and P = 0.0089, respectively). Higher rCSA of the paraspinal and psoas major muscles did not correlate with better outcomes measured using ODI, COMI and VAS scales (P ≥ 0.072). Conclusion: The degree of fatty degeneration of the paraspinal muscles correlates with better outcomes 1 and 6 months after microdiscectomy. [ABSTRACT FROM AUTHOR]

Objective  To study the indications, technical nuances, learning curve, and outcomes associated with minimally invasive tubular discectomy of spine (MITDS) and minimally invasive tubular decompression (MITD) using the tubular retractor system and compare the outcomes with open microdiscectomy and open decompression. Materials and Methods  All patients who underwent MITDS and MITD received a trial of conservative management for 6 weeks prior to surgery. Patients who had undergone open microdiscectomy and open decompression during the same period were used as controls. Operating time, intraoperative blood loss, preop and postop visual analogue scale (VAS) scores, preop and postop Oswestry disability index (ODI) scores, duration of hospital stay, complications, and need for redo surgery were analyzed. Results  Thirty-two patients who underwent MITDS and 8 patients who underwent MITD were compared with an equal number of patients who underwent open microdiscectomy and open decompression, respectively. MITDS and MITD were associated with shorter hospital stay. Short-term pain outcome was better in MITDS and MITD group, although it was not statistically significant in MITD group. Functional outcome measured in terms of ODI at 6 months was not statistically significant between minimally invasive and open procedures. Conclusion  Both MITDS and MITD have a significant learning curve and have a distinct advantage of shorter hospital stay. MITDS has the distinct advantage of better short-term pain relief compared with open procedures. For MITD, comparison of short-term pain relief requires a larger sample size. To establish long-term advantages of MITDS and MITD, larger sample size and long-term follow-up are needed. [ABSTRACT FROM AUTHOR]

Abstract Background To investigate the association between interleukin-6 (IL-6) (rs1800795, rs1800796, rs1800797, rs13306435, rs2069849) and interleukin-10 (IL-10) (rs1800871, rs1800896) gene polymorphisms, expression levels, and lumbar disc disease (LDD). Methods We conducted a literature research on PubMed, Embase, Web of Science, Cochrane Library, and China National Knowledge Infrastructure (CNKI) until February 28, 2019. We included all case-control studies about the association between IL-6 and IL-10 gene polymorphisms and LDD. The odds ratio (OR) and 95% confidence interval (CI) were calculated to estimate the strength of association. Statistical analysis was conducted by Review Manager (RevMan) 5.3 software. Furthermore, immunohistochemistry (IHC) and RT-PCR were performed to evaluate IL-6 and IL-10 expressions in the normal and degenerated disc. Results A total of 6 studies, involving 1456 cases and 1611 controls, were included in this meta-analysis. G alleles of rs1800795 and rs1800797 in the IL-6 gene were significantly associated with LDD (rs1800795: G vs. C, OR = 1.38, 95% CI = 1.16–1.64, P = 0.0002; rs1800797: G vs. A, OR = 1.35, 95% CI = 1.14–1.61, P = 0.0006). Begg’s funnel plot and Egger’s tests did not show any evidence of publication bias. IL-6 expression and IL-6 mRNA levels were significantly increased in the degenerated disc compared with those in the normal disc (IL-6 immunopositive cells, 73.68 ± 10.99% vs. 37.23 ± 6.42%, P

Background The distribution characteristics of gender, age, and season and the influence of season on the length of hospitalization stay (LOS) were analyzed based on the information of inpatients about various diseases. Methods A total of 5575 patients’ basic information (gender, age, hospitalization time, season of onset) of five diseases was classified according to spring, summer, autumn, winter. Their distribution characteristics were analysed using T‐test, one‐way ANOVA, Chi‐square test. Then the data were incorporated into SPSS 21.0 for statistical analysis. Results Most cases of cranial chronic vascular disease (CCVD) were found in summer (53% of cases), less in spring, and no cases in winter. The LOS was longer for middle‐aged men, elderly men, and elderly women in the fall group than in the spring group (p < 0.05). The LOS was longer in the fall group than in the summer group for older men and older women (p < 0.05). Herpes zoster cases were more frequent in summer (43%) and autumn (56.30%), less frequent in spring (1.20%), and no cases in winter. Middle‐aged and elderly men in the summer group had longer LOS than the autumn group (p < 0.05). The most cases of cervical spondylosis were found in the spring (42.00%), the fewest were found in the fall (0.10%). Cases of knee osteoarthritis were the most in winter (53.40%) and fewer in summer (7%) and autumn (9.80%). Conclusion CCVD, herpes zoster, cervical spondylosis, and knee osteoarthritis have an obvious seasonal distribution, and seasons have a certain impact on the hospitalization time of patients with CCVD or herpes zoster, especially in older men.

Introduction: Lumbar disc disease is one of the common causes of lower back pain caused by a change in the structure of the normal disc. Most of the time, disc disease happens as a result of aging and the normal breakdown that occurs within the disc. Caudal epidural steroid injections are the popular treatment for patients with chronic low back pain that does not respond to conservative management., Method: A retrospective survey was administered to 160 patients who had received caudal epidural injections for chronic low back pain in the past, but only 74 patients who completed the scheduled follow-ups were included in the study. They were divided into two groups based on the imaging modality used for guiding the caudal epidural steroid injections, either ultrasonography or fluoroscopy, and then assessed for improvement in pain on the Numeric Rating Scale (NRS), for functional improvement on the Oswestry Disability Index (ODI), and for satisfaction on the North American Spine Society Patient Satisfaction Scale (SSPSS)., Results: Mean NRS pain scores improved significantly from baseline at 6.78 and 7.00 in the fluoroscopy and ultrasound groups, respectively, to 2.03 and 2.16 at 12 weeks post-procedure. The difference between the groups was not statistically significant (p > 0.05). The Oswestry Disability Index was completed at baseline and after 12 weeks of follow-up for both groups, and there was no significant difference between the two groups; the fluoroscopy group's mean Oswestry Disability Index scores were 52.4 at baseline and 35.6 at 12 weeks, whereas the scores for the ultrasound group were 50.3 at baseline and 37.9 at 12 weeks. Conversely, patient satisfaction as assessed using the SSPSS rose in both groups up to 12 weeks (p > 0.05)., Conclusion: The ultrasound- and fluoroscopy-guided caudal epidural steroid injections proved equally effective in easing the pain, disability, and satisfaction levels of patients with chronic lower back pain., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. The Institutional Human Ethics Committee of All India Institute of Medical Sciences (AIIMS), Bhopal, issued approval IHEC-LOP/2020/IM0319. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Gupt et al.)

Chronic spinal disc disease has a large socioeconomic impact on the health care system. A lot of researchers confirm that physiotherapy (PT) is an effective choice of treatment for many patients. The aim of the present study is to evaluate the combined effect of physiotherapy and balneotherapy the treatment of lumbar disc disease and to compare the results with those obtained only after physio-therapy. Twenty patients with lumbar disc disease in the chronic period, divided into two groups – experimental and control were studied. The experimental group did exercises in a thermal mineral pool and underwent a general PT program for ten days, while the control group had only general PT program for ten days. The general PT program was the same for both groups. Before and after the treatment the Schober test and the static part of the Kraus-Weber test were conducted. We revealed significant positive changes in the lumbar flexibility, endurance and strength of the back muscles, mm. glutei, abdominal muscles and the hip flexors among the patients from the experimental group, objectified by the increased time to perform the static test positions of Kraus-Weber Test and Schober test. We recommend our program with PT and balneotherapy as appropriate when dealing with patients with chronic lumbar spine disease in balneological resorts and SPA hotels.

Due to increasing longevity, the incidence of degenerative lumbar disc diseases has increased, and surgical treatment is often necessary. In this context, the anterior approach becomes an important technique. However, one of the main limitations of this method is the need for dedicated retractors, which requires larger incisions for its positioning and increases the cost of the procedure. The objective of the present study was to describe a technique for retracting abdominal structures by anterior approaches to the lumbar spine using Steinmann wires. This manuscript consists of a technique description of anterior approach for lumbar spine. Surgical treatment of degenerative lumbar spine disease is often necessary when the patients have symptoms refractory to conservative treatments. Many of them will be candidates for surgical treatment with anterior approach, either for arthrodesis/anterior lumbar interbody fusion or arthroplasty. Small incisions are performed for positioning the modified Langenbeck retractors and the Steinmann wires. These retractors are easily positioned and provide good exposure of the lumbar discs making it possible to implant appropriate cages for restoring the necessary height, lordosis, and sagittal balance. The technique described is safe, inexpensive, and reproducible. Simple and easily accessible instruments are required in most hospital complexes. [ABSTRACT FROM AUTHOR]

Purpose: The objective was to evaluate the occupational vibration acting under grapple skidder operators during skidding operation of the Eucalyptus tree bundles. Methods: The collection of the whole-body vibration data was based on the methodology recommended by the International Organization for Standardization (ISO 8041 and ISO 2631). Then, technical procedure for obtaining vibration data from the operators was performed using a Larson Davis tri-axial vibration meter, model HVM 200 and a tri-axial ICP accelerometer of the seat pad type. Results: When comparing the values of the weighted acceleration and VDV with the limits established by the European Directive, it is verified that in both tests, the measured values are higher than the one expected by the respective regulation. Compared to the ISO 2631 criteria, both tests provided results located in the danger zone. Conclusion: The values obtained indicate that occupational exposure may cause health risks to grapple skidder operators. The results showed the need of actions that can minimize the transmission of vibration to the operators due to the level being above the guidelines, despite all the technology used by manufacturers of machinery for harvesting. [ABSTRACT FROM AUTHOR]